| NPI | 1417429374 |
|---|---|
| Doing Business As | HEALTHSOURCE OF SOUTHSIDE AIKEN |
| Entity Type | Organization |
| Authorized Contact | ETHAN VANFOSSEN Owner 864-303-2679 |
| Organization Subpart ? | No |
| Primary Taxonomy | 111N00000X Chiropractor |
| Enumeration Date | 2018-12-17 |
| Last Update Date | 2019-01-02 |